Provider Demographics
NPI:1932391810
Name:HICKS, NOVELLA (MSW)
Entity Type:Individual
Prefix:
First Name:NOVELLA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:NOVELLA
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-1705
Mailing Address - Country:US
Mailing Address - Phone:415-206-7613
Mailing Address - Fax:
Practice Address - Street 1:600 ANTON BLVD FL 11
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7100
Practice Address - Country:US
Practice Address - Phone:623-374-7774
Practice Address - Fax:855-420-6361
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health